I don't know how to fix the overadvanced jaw my DJS gave me, please help

[varbrah]

I would advise AGAINST doing anything to the area that looks relatively recessed via comparison to the double jaw advancement. Like NO CHEEK implants or any implants to to the area. This is because the slightly 'conCAVE' area below the eyes looks very GOOD in FRONTAL view. There is a scientific reason for that. Leonardo DaVinci explained it better than me in his treatise. But it has to do with a concave area 'catching' MORE LIGHT. For example in full frontal view, you have NO SHADOWING to the area below the eyes. So, if you start adding a conVEXity there via implants, you would look more 'off' to yourself.

I may be misunderstanding, but feel like this would be more of an issue with off-the-shelf malar implants that don't augment the infraorbital rim or otherwise provide for excessive augmentation of the anterior zygoma and/or submalar area (typically only appropriate for female cases).

Should be able to mitigate this by designing the implant such that: a) it also augments the infraorbital rim, and b) takes into consideration gender-specific/dimorphic differences in zygomatic growth patterns, i.e. malar augmentation should be primarily to the upper/lateral aspects of the zygoma for men, with a superiorly positioned and reduced prominence as compared to a female design. Can be mitigated further as 3D-printed implants can be modeled to approximate the subject's underlying structure thereby preserving skeletal contours.

[kanko]

OP himself mentioned he has social anxiety and is currently experiencing a severe bout of BDD - it's totally possible he's acting a bit skittish/self-conscious in public and people are catching a weird vibe. It may also simply be anxiety bleeding into and clouding his perception of how others are treating him.

Both scenarios are more likely than strangers actually treating him poorly due to him having masc/ogre looks (because he doesn't) or because he's frowning / his brow is furrowed. Is shooting dirty looks at people for having mild prognathism a consistent phenomenon or something? Do people act significantly weirded out and uncomfortable when interacting with anyone who looks slightly worried/stressed?

Anyway, no - The main aesthetic issue is the fundamental difference in projection between the LF1 area comprising the inferior maxilla/dentoalveolar ridge/anterior nasal spine vs. the superior nasomaxillary complex and anterior malar/zygomatic complex.

Filling out the radix/dorsum will give him back his natural, phenotype-appropriate nasal shape and compensate for the 'relative' loss of nasal projection due to his rather large 10mm advancement. OP is neither a Kpop star nor a woman - a de-projected, small and upturned nose does not occur on rather robust European male faces in nature.

Additionally, from a soft tissue perspective, Subnasale should be (or appear to be) in relative vertical alignment with the anterior-most edge of the nasal bridge. Subnasale appears more projected than the nasal bridge, therefore achieving appropriate balance between the two requires nasal augmentation.

Btw insane that you think an adequately-projected, elegant, straight nose will make OP look more like an ogre lmao.

Adequately projected? Natural? Come on dude your second morph makes him look like those people that fix the nasal hump with hialuronic acid, just looks bad and not natural in any way. His natural and adequately projected nasal bridge is the one he has now which wasnt affected by surgeries. He did gain tip projection from his maxillary advancement so if anything what he should change is the TIP and deproject it. That gives him a straight nose

Also your suggestion also avances de n’ point and that makes OPs face looks less forward grown and more retangular.
So i think your suggestion goes against what OP is complaining about and makes him look flat faced instead of forward grown.
He already thinks he is lacking forward growth. (Not something i agree with)

Insane the you would think that would in any way help op. He already has bdd from the surgeries he had, lets make another face part look unnatural

[kanko]

Shouldn't be a big deal to evaluate and potentially plan around for any halfway decent surgeon.

I said it because op was evaluating only reducing the chin, which to me is a bad idea. He should take the whole mandible in account. No need to be all condescending on the advice just because i dont agree with you

[varbrah]

Adequately projected? Natural? Come on dude your second morph makes him look like those people that fix the nasal hump with hialuronic acid, just looks bad and not natural in any way. His natural and adequately projected nasal bridge is the one he has now which wasnt affected by surgeries. He did gain tip projection from his maxillary advancement so if anything what he should change is the TIP and deproject it. That gives him a straight nose

Also your suggestion also avances de n’ point and that makes OPs face looks less forward grown and more retangular.
So i think your suggestion goes against what OP is complaining about and makes him look flat faced instead of forward grown.
He already thinks he is lacking forward growth. (Not something i agree with)

Insane the you would think that would in any way help op. He already has bdd from the surgeries he had, lets make another face part look unnatural

I made those in GIMP in 5 minutes, quick workups for demonstration. While not perfect, both are an improvement.

OP's nose was natural and well-suited to his face PRIOR to bimax. Massive CCW rotation and 10mm advancement at the LF1 level have substantially changed the relationship such that the mobilized and non-mobilized are now in disharmony. Were the bite to advance to its current position via natural growth processes, the nasal complex (as part of the maxilla) would have likewise advanced in a counter-clockwise rotational fashion.

This phenomenon can be observed with trans-sutural distraction osteogenesis, where the entire maxilla displaces and rotates as a unit:

https://i.imgur.com/uXUErKH.jpg

The skeletal disharmony between the mobilized and non-mobilized segments needs to be corrected. For the nose and upper midface, this means creating a pseudo-CCW rotation and advancement, respectively.

You're correct that the absolute projection of the nasal tip has increased, but the relative distance from key soft tissue facial landmarks has actually decreased. Therefore, no - the nasal tip is no longer adequately projected as compared to the lips, paranasal, etc. The reason OP needed a rhinoplasty to correct his flaring was precisely because the distance between the tip and paranasal tissues decreased in the A-P dimension, with the nostrils then forced to occupy space in the transverse dimension/laterally.

Advancing Nasion is not an issue and would actually be desirable given that the aesthetic ideal is for the upper incisors and Nasion to be aligned along a vertical plane when subject's FH plane is level. OP's upper incisors are well ahead of his Nasion, creating substantial disharmony.

Not insane at all. The maxilla does not grow segmentally. Visually approximating and restoring the previous skeletal/soft tissue relationships and proportions would get OP back to looking more like himself, potentially resolving the dysphoria/BDD. Likewise augmenting the nose and midface will make his mandible appear less prognathic. Two birds one stone.

[kavan]

I may be misunderstanding, but feel like this would be more of an issue with off-the-shelf malar implants that don't augment the infraorbital rim or otherwise provide for excessive augmentation of the anterior zygoma and/or submalar area (typically only appropriate for female cases).

Should be able to mitigate this by designing the implant such that: a) it also augments the infraorbital rim, and b) takes into consideration gender-specific/dimorphic differences in zygomatic growth patterns, i.e. malar augmentation should be primarily to the upper/lateral aspects of the zygoma for men, with a superiorly positioned and reduced prominence as compared to a female design. Can be mitigated further as 3D-printed implants can be modeled to approximate the subject's underlying structure thereby preserving skeletal contours.

Hi,

As to someone OTHER than the OP understanding/misunderstanding or having a different 'take' than I provide an OP of a thead, it doesn't matter because my advice is to an OP and not a 3rd party other than the OP.

I've spent adequate time giving my 'take' to the OP. I have no objections if you have a different take. But I need to point out that if a different 'take'/opinion ends up confusing the OP, I don't promise or imply to promise to resolve confusion the OP might have via differing opinions. I give my take,someone else gives theirs. It's up to the OP to choose which advice or 'take' they want to take.

[kanko]

I made those in GIMP in 5 minutes, quick workups for demonstration. While not perfect, both are an improvement.

OP's nose was natural and well-suited to his face PRIOR to bimax. Massive CCW rotation and 10mm advancement at the LF1 level have substantially changed the relationship such that the mobilized and non-mobilized are now in disharmony. Were the bite to advance to its current position via natural growth processes, the nasal complex (as part of the maxilla) would have likewise advanced in a counter-clockwise rotational fashion.

This phenomenon can be observed with trans-sutural distraction osteogenesis, where the entire maxilla displaces and rotates as a unit:

https://i.imgur.com/uXUErKH.jpg

The skeletal disharmony between the mobilized and non-mobilized segments needs to be corrected. For the nose and upper midface, this means creating a pseudo-CCW rotation and advancement, respectively.

You're correct that the absolute projection of the nasal tip has increased, but the relative distance from key soft tissue facial landmarks has actually decreased. Therefore, no - the nasal tip is no longer adequately projected as compared to the lips, paranasal, etc. The reason OP needed a rhinoplasty to correct his flaring was precisely because the distance between the tip and paranasal tissues decreased in the A-P dimension, with the nostrils then forced to occupy space in the transverse dimension/laterally.

Advancing Nasion is not an issue and would actually be desirable given that the aesthetic ideal is for the upper incisors and Nasion to be aligned along a vertical plane when subject's FH plane is level. OP's upper incisors are well ahead of his Nasion, creating substantial disharmony.

Not insane at all. The maxilla does not grow segmentally. Visually approximating and restoring the previous skeletal/soft tissue relationships and proportions would get OP back to looking more like himself, potentially resolving the dysphoria/BDD. Likewise augmenting the nose and midface will make his mandible appear less prognathic. Two birds one stone.

The image you just posted in no way correlates to what you morphed him into on the second picture.

Filling out and advancing his soft tissue nasion would just look comical and also destroy his nice looking brow ridge as happens in the image below

Also from your own image, the nasion is not advanced in a meaningfull way as you previously did.

He looks prognatic due to his upper lip being behind the lower lip and the chin, which would resolve by setting the lower lip and the chin back.

Also the upper incisor may be aligned to the soft tissue nasion, and still that should be used as a guideline and not as a set in stone line. From alfaros own article, most attractive people are ahead of the line. So it has been treated as a minimum, not a maximum. Still messing with his nose does not fix his upper lip/lower lip/ chin relationship.

[varbrah]

Hi,

As to someone OTHER than the OP understanding/misunderstanding or having a different 'take' than I provide an OP of a thead, it doesn't matter because my advice is to an OP and not a 3rd party other than the OP.

I've spent adequate time giving my 'take' to the OP. I have no objections if you have a different take. But I need to point out that if a different 'take'/opinion ends up confusing the OP, I don't promise or imply to promise to resolve confusion the OP might have via differing opinions. I give my take,someone else gives theirs. It's up to the OP to choose which advice or 'take' they want to take.

Got it, but I was genuinely interested in getting additional detail on the issue you referenced since the initial explanation was a bit unclear. I first expounded on my understanding/thought process in regards to what I *assumed* you were talking about, so as to first contribute something of my own to the discourse without being a leech and simply demanding to be spoonfed. I also left the door open for you to come in and correct my assumption, hence "I may be misunderstanding", so I was not countering your take by any means.

All good if you don't want to exchange ideas.

[varbrah]

The image you just posted in no way correlates to what you morphed him into on the second picture.

Filling out and advancing his soft tissue nasion would just look comical and also destroy his nice looking brow ridge as happens in the image below

Also from your own image, the nasion is not advanced in a meaningfull way as you previously did.

He looks prognatic due to his upper lip being behind the lower lip and the chin, which would resolve by setting the lower lip and the chin back.

Also the upper incisor may be aligned to the soft tissue nasion, and still that should be used as a guideline and not as a set in stone line. From alfaros own article, most attractive people are ahead of the line. So it has been treated as a minimum, not a maximum. Still messing with his nose does not fix his upper lip/lower lip/ chin relationship.

In the post you're quoting I explained that I made the edits in 5 minutes and that they are not ideal, rather, conceptual.

Here is a (demonstrative, not definitive) superimposition of the 'before' soft tissue profile in-line with the bimaxillary advancement - models the relative preservation of the relationship between the nose/lips/chin should the maxillary advancement have occurred uniformly.

https://im.ezgif.com/tmp/ezgif-1-d802bf181a.gif

My point was also that he appears *more* prognathic due to the lower lip incompetency. Also, the adverse aesthetic impact of the lower lip incompetency is exacerbated by the relatively diminished nasal projection post-bimax. His facial profile is fundamentally out of balance and requires augmentation of the middle third in order to correct the facial concavity downstream of the mandible. The other alternative is revision bimax, which is considerably more expensive and brutal than an augmentation rhino.

I kind of don't agree with Alfaro's reference plane in regards to orthognathic surgery. Arnett and Gunson's produces superior results, imo. True though, that the most attractive people *are* ahead of this line - but, I'd keep in mind that they grew that way naturally with all the complementary and accompanying structural changes across the facial skeleton and adequate projection across the entire maxilla and adjacent facial bones. Everything *fits* in that sense, whereas attempting to mimic this with standalone segmental osteotomies might make you look out of place.

[kanko]

In the post you're quoting I explained that I made the edits in 5 minutes and that they are not ideal, rather, conceptual.

Here is a (demonstrative, not definitive) superimposition of the 'before' soft tissue profile in-line with the bimaxillary advancement - models the relative preservation of the relationship between the nose/lips/chin should the maxillary advancement have occurred uniformly.

https://im.ezgif.com/tmp/ezgif-1-d802bf181a.gif

My point was also that he appears *more* prognathic due to the lower lip incompetency. Also, the adverse aesthetic impact of the lower lip incompetency is exacerbated by the relatively diminished nasal projection post-bimax. His facial profile is fundamentally out of balance and requires augmentation of the middle third in order to correct the facial convexity downstream of the mandible. The other alternative is revision bimax, which is considerably more expensive and brutal than an augmentation rhino.

I kind of don't agree with Alfaro's reference plane in regards to orthognathic surgery. Arnett and Gunson's produces superior results, imo. True though, that the most attractive people *are* ahead of this line - but, I'd keep in mind that they grew that way naturally with all the complementary and accompanying structural changes across the facial skeleton and adequate projection across the entire maxilla and adjacent facial bones. Everything *fits* in that sense, whereas attempting to mimic this with standalone segmental osteotomies might make you look out of place.

You are using a bad image that doesnt do good to op since its his post op picture. He also did a rhino and his implants after it. Plus he is proably swolen.


This is what would be good to OP https://im.ezgif.com/tmp/ezgif-1-fc0c862199.gif

No, you explicitly said the OP upper lower lip and chin relation was good, which doesnt look like the case

[kanko]

In the post you're quoting I explained that I made the edits in 5 minutes and that they are not ideal, rather, conceptual.

Here is a (demonstrative, not definitive) superimposition of the 'before' soft tissue profile in-line with the bimaxillary advancement - models the relative preservation of the relationship between the nose/lips/chin should the maxillary advancement have occurred uniformly.

https://im.ezgif.com/tmp/ezgif-1-d802bf181a.gif

My point was also that he appears *more* prognathic due to the lower lip incompetency. Also, the adverse aesthetic impact of the lower lip incompetency is exacerbated by the relatively diminished nasal projection post-bimax. His facial profile is fundamentally out of balance and requires augmentation of the middle third in order to correct the facial concavity downstream of the mandible. The other alternative is revision bimax, which is considerably more expensive and brutal than an augmentation rhino.

I kind of don't agree with Alfaro's reference plane in regards to orthognathic surgery. Arnett and Gunson's produces superior results, imo. True though, that the most attractive people *are* ahead of this line - but, I'd keep in mind that they grew that way naturally with all the complementary and accompanying structural changes across the facial skeleton and adequate projection across the entire maxilla and adjacent facial bones. Everything *fits* in that sense, whereas attempting to mimic this with standalone segmental osteotomies might make you look out of place.

I do like arnett and gunsons relations and think they are good. But in my opinion OP has good maxillary advancement and it looks good on him. That may not happen in other cases as you said. His issue, if we are to say he has one, is on the mandible. Messing with other stuff wont change that

[varbrah]

You are using a bad image that doesnt do good to op since its his post op picture. He also did a rhino and his implants after it. Plus he is proably swolen.


This is what would be good to OP https://im.ezgif.com/tmp/ezgif-1-fc0c862199.gif

No, you explicitly said the OP upper lower lip and chin relation was good, which doesnt look like the case

The original pre- and post-bimax photos are the only good comparables, so no.

I'm pretty sure his rhino was primarily for alar base reduction. Also, that doesn't at all impact my thesis about the nose needing more projection. It still looks under-projected pre- and post-rhinoplasty. I'm analyzing the profile so gonial angle implants don't make a difference either.

And yeah, because the lower lip is totally fine in that position if you first augment a) nasal projection, b) malar-zygomatic volume. Very dishonorable to ignore the ample context I've provided good sir!

Maybe not even necessary, but last order of business would be addressing the lower lip incompetency with either myofunctional therapy (if possible, i.e. not a structural issue), soft tissue surgery, and/or vertical reduction genioplasty for structural correction.

[kanko]

The original pre- and post-bimax photos are the only good comparables, so no.

I'm pretty sure his rhino was primarily for alar base reduction. Also, that doesn't at all impact my thesis about the nose needing more projection. It still looks under-projected pre- and post-rhinoplasty. I'm analyzing the profile so gonial angle implants don't make a difference either.

And yeah, because the lower lip is totally fine in that position if you first augment a) nasal projection, b) malar-zygomatic volume. Very dishonorable to ignore the ample context I've provided good sir!

Maybe not even necessary, but last order of business would be addressing the lower lip incompetency with either myofunctional therapy (if possible, i.e. not a structural issue), soft tissue surgery, and/or vertical reduction genioplasty for structural correction.

Yeah use the one picture where his soft tissues are different from his current ones, on the post op one his lips are good-ish, which is not the case on all of his current pictures.

You are saying lower lip ahead of upper lip is ok? No way

[varbrah]

Yeah use the one picture where his soft tissues are different from his current ones, on the post op one his lips are good, which is not the case on all of his current pictures.

You are saying lower lip ahead of upper lip is ok? No way

Dolph Lundgren rocks it.

But yeah - you’re right, it’s not ideal. It’s lowest on my list because definitively correcting the lower lip will require a revision bimax in order to move B point behind A point. This wouldn’t be a huge aesthetic boost standalone, but would require the most effort, ie decompensation, surgery/recovery, $$$. He would then need to dish out for implant revision and it’s possible a revision Lf1 movement might change the nose again, so potentially another rhino.

As I’ve been saying a superior tradeoff in my view is to leave the jaws alone, balance/camouflage the mild prognathism with midfacial/nasal augmentation, and after all that maybe reduce the severity of the lip incompetence with genio if necessary

[kavan]

Got it, but I was genuinely interested in getting additional detail on the issue you referenced since the initial explanation was a bit unclear. I first expounded on my understanding/thought process in regards to what I *assumed* you were talking about, so as to first contribute something of my own to the discourse without being a leech and simply demanding to be spoonfed. I also left the door open for you to come in and correct my assumption, hence "I may be misunderstanding", so I was not countering your take by any means.

All good if you don't want to exchange ideas.

I'm not up to the task of cross referencing, correcting, explaining my own advice relative to someone elses etc. if a 3rd party wants that from me subsequent to my giving my take to an OP in a thread. As I see it, I've already exchanged my ideas with the relevant party; the OP.

[Glassjaw]

I feel like I have a very weird face IRL, whereas in pictures I look moderately attractive. People avoid eye contact with me or look at me weird. People seem weirded out after interacting with me and never smile. I think the problem is nothing in my face matches, making me look uncanny:
-   High nasolabial angle and slightly feminin nose with a strong jaw.
-   The wide square jaw with slightly protusive chin doesn’t match a narrow smile and palate (even with a small mouth, bucal corridors are visible when I smile), and a downturned mandible/chin.

I really ask for your help. Is it just very severe body dismorphia?[/size]

You sound quite anxious and insecure about your looks in your post, and if that's true, then people are probably seeing that on your face and that's why they seem weirded out. Who knows, you might even have mental issues you haven't yet noticed that cause you to make strange gestures. That's always a possibility. But it's certainly not directly your looks that causes this, unless it's people you've known before your surgeries, because if it is that, then they are probably just wondering what is different about you.

I think you need to calm down about this. I personally don't see anything wrong with your face. The gonial angle is steepish, but so what, i've seen worse and your jaws are strong and masculine looking. I think you look just fine, no additional surgeries needed.